Tetanus and Diphtheria Vaccinations Billing GuidelinesCPT CodeICD-1090715S61011A90471S61011AAug 30, 2018
Article - Billing and Coding: Tetanus Immunization (A52438)
Routine tetanus vaccination services are not covered by Medicare. If you are billing for a routine tetanus vaccination, it is recommended to append the GY modifier.
ICD-10 requires only one code (Z23) per vaccination, regardless if single or combination. Report Z23 for all vaccination diagnoses.
For the TDAP vaccine, report CPT code 90715 (pays approximately $31).
90698 Diphtheria, tetanus toxoids, acellular pertussis vaccine, hemophilus influenza Type B, and poliovirus vaccine, inactivated (DTaP-HIB-IPV), for intramuscular use. 90700 diphtheria, tetanus toxoids, acellular pertussis vaccine (DtaP), when administered to individuals younger than 7 years, for intramuscular use.
If you receive a Tetanus shot because you haven't had one in a long time (more than ten years) the injection would not be covered by Medicare Part B. Your physician's office would be considered out of network for this billing- because the office is not considered a pharmacy.
Medicare covers tetanus shots, but the reason you need one will determine which part pays for it. Medicare Part B covers tetanus shots after an injury or illness. Medicare Part D covers the regular tetanus booster shot. Medicare Advantage plans (Part C) also cover both types of shots.
Medicare prescription drug coverage (Part D) usually covers all commercially available vaccines needed to prevent illness, including the Tdap shot.
According to ICD-10-CM guidelines, clinicians may assign code Z28. 310, “Unvaccinated for COVID-19,” when the patient has not received a dose of any COVID-19 vaccine. Clinicians may assign code Z28.
Code Z23 is used to indicate any encounter for a vaccination. The procedure codes are used to identify the type of the immunization given and how it was administered.
Inoculations and Vaccinations ICD-10-CM Coding Code Z23, which is used to identify encounters for inoculations and vaccinations, indicates that a patient is being seen to receive a prophylactic inoculation against a disease.